Orbital compartment syndrome (OCS) is an ocular emergency that is characterized by increased intraocular pressure (IOP). If untreated, optic nerve ischemia will develop, resulting in irreversible vision loss in as little as 90 to 120 minutes. Immediate vision saving treatment via lateral canthotomy and cantholysis is required. OCS is most commonly a result of retrobulbar hemorrhage secondary to trauma, but can also be iatrogenic, due to infection or inflammation.

 Primary Indications

    Retrobulbar hemorrhage with the following:

       Acute loss of visual acuity

       IOP >40 mm Hg

       Severe proptosis

       Marked periorbital edema

       An unconscious or uncooperative patient with an IOP >40 mm Hg

 Secondary Indications

    Suspected retrobulbar process with the following:

       Associated afferent pupillary defect

       Ophthalmoplegia

       Resistance to retropulsion

       Cherry-red macula

       Optic nerve head pallor

       Severe eye pain

CONTRAINDICATIONS

 Suspected ruptured globe

LANDMARKS

 The lateral canthal tendon is a combined tendon–ligament that provides structural fixation of the lids (tarsal plates) and orbicularis oculi muscle to the inner aspect of the bony lateral orbital wall (zygoma) just posterior to the orbital rim

 The tendon has an inferior and superior crux

 The point at which the tendon attaches is called Whitnall tubercle

 Eisler pocket, a small pocket of orbital fat, lies anterior to the lateral canthal tendon

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